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General NPI Number Information
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NPI Number | 1679514392
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Entity Type | Individual
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Provider Name | BERNARD H AGNEW FNP
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 1481 HWY 40 E
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City | KINGSLAND
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State | GA
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Zip | 31548-6507
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Country | US
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Telephone | 860-287-0738
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Fax |
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Provider Business Mailing Address
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Address Line | 3023 ALBACORE CIR
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City | SILVERDALE
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State | WA
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Zip | 98315-9780
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Country | US
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Telephone | 360-535-7080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN283456
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State |
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